Montgomery County

Mental /Behavioral Health

County leaders face the reality of mental illness inside prison, and adopt a promising new approach

Intelligencer Journal - 12/5/2018

THE ISSUE

As LNP staff writer Jeff Hawkes reported in last week’s Sunday LNP, experts estimate that about 2 million Americans with serious mental illnesses are incarcerated every year. This, he noted, is “in part a consequence of a 90 percent reduction in the number of beds at state psychiatric hospitals since the 1950s. Lancaster County Prison averages 850 inmates, and at any given time, 40 to 50 have a diagnosis of a serious mental illness. In a typical month, the prison psychiatrist sees 150 to 230 inmates, or roughly one out of four.”

It’s been said repeatedly because it’s so painfully evident: After most state hospitals closed, prisons became de facto mental health facilities, housing, as Hawkes wrote, “people who might never have broken the law if their psychiatric conditions were under control.”

Unfortunately — a word that seems inadequate in this context — prisons were poorly equipped to meet the needs of inmates wrestling with serious mental illness.

At Lancaster County Prison, as Hawkes unflinchingly described it, officials had little choice but to warehouse unstable inmates in “stark cells in the two-tier medical housing unit,” a “grim, windowless, concrete-and-steel chamber where the ventilation system and shower-exhaust fan create an unrelenting drone.”

In such an environment, Hawkes noted, “problems mounted, including suicide attempts, other kinds of self-harm and assaults on inmates and staff.”

Sgt. Louis Chirichello, a supervisor who has worked at Lancaster County Prison for 24 years, acknowledged the reality. “Everyone knows we had a problem with suicides. A lot of that was letting these mental health issues just deteriorate. No program in place. No training. It was very frustrating.”

It was not just frustrating. It could be argued that it was inhumane. Incarceration became, for some inmates, a death sentence, and for their families, the price was lifelong sorrow.

For prison employees, too, we’re sure the price was unreasonably high. No one wants to be part of failure, and the suicide of an inmate represents the terrible failure of a system to work as it should. Even if that system wasn’t designed to handle that particular challenge.

A new approach

Into this bleak landscape walked Josh Parsons, chairman of the Lancaster County Board of Commissioners, and prison Warden Cheryl Steberger.

They have spearheaded what Hawkes described as a new “proactive, commonsense approach” to handling mental illness at the prison.

In August 2016, they launched a program called PrisonStat, and held hearings diving “into the weeds of prison operations to identify problems and find solutions,” Hawkes explained. “That initiative documented the degree to which mentally ill inmates were responsible for a disproportionate share of assaults and use-of-force incidents.”

After the deaths of three inmates by hanging in early 2015, the county established a suicide prevention task force, and members visited Lehigh County to learn about its multidisciplinary approach to working with mentally ill inmates.

In January 2017, Parsons and Steberger began holding monthly internal meetings, “modeled on Lehigh County’s initiative, to strategize how to help inmates with the most severe psychiatric issues,” Hawkes noted.

The result: an intentional effort in which prison, mental health and criminal justice specialists work together to improve the outcomes of inmates with severe mental illness.

The team attending these monthly meetings includes the director of the county’s behavioral health department, mental health caseworkers, prison supervisors, prison medical staff members, the chief public defender, an assistant district attorney and a representative from Adult Probation and Parole Services.

Ten to 20 inmates are discussed at each monthly meeting, and the team develops behavioral and post-release plans for each of those individuals — and assigns tasks that are to be accomplished before the next meeting.

This strikes us as the crucial element: “Someone is accountable” for each inmate discussed, Parsons told Hawkes. “The real work is done between the meetings.”

When accountability is assigned, expectations are not only raised, but raised in a way that is realistic. Because the workload is manageable; divvying up the responsibility for the inmates makes it more likely that warning signs will be caught, behaviors will be detected and addressed, and importantly, each inmate will be seen as an individual, with unique mental health issues and needs.

This, as Parsons and Steberger see it, helps not only those individuals, but also should help to reduce recidivism and improve public safety.

“The overall goal is to have stability while they’re in (jail), but also some plan if they’re getting out,” Parsons told Hawkes. “We realize mentally ill inmates are going to come right back in the door if there’s no plan.”

Steberger wisely has also improved staff training, so that staff members now take a three-hour mental health first-aid course and annual suicide prevention training. And 95 corrections officers have taken a weeklong crisis intervention training that emphasizes de-escalating a crisis.

Why it’s important

There are real reasons — beyond basic humanity — to be concerned with the welfare of the inmates of Lancaster County Prison.

As Hawkes reported, the prison “houses those unable to make bail ahead of trial and those serving sentences of less than two years. County taxpayers foot the $27 million annual bill — about $87 a day per inmate.”

Reducing recidivism, and the lawsuits that stemmed from suicides, saves taxpayer money.

And addressing the mental health of inmates helps not just them but prison staff members.

Chirichello told the graphic and disturbing story of an unmedicated inmate who posed a threat to others around him, and smeared feces on cell walls.

In the past, he said, corrections officers would have dealt with the behavior for days while waiting for counselors and others to address it. Imagine, if you can, how harrowing that wait would be for those corrections officers.

Now the team would work to stabilize the inmate, move his criminal charges to resolution and create a housing and treatment plan for his return to the community.

If necessary, the inmate could receive inpatient treatment under a 2017 agreement between the county and Lancaster General Health. The new 126-bed Lancaster Behavioral Health Hospital should be an excellent resource for the prison.

“This thing of locking them up and letting them scream and hit their head all day, those days are over with,” Chirichello told Hawkes.

And, for everyone involved, thankfully so.

We laud Parsons and Steberger for their willingness to discard outdated and unhelpful operating methods, and for seeking out better ways of dealing with a thorny and multilayered problem.

It’s still far from ideal that, for too many people, incarceration represents their best chance of receiving mental health treatment.

But ignoring this reality won’t make it go away. We’re grateful we have leaders in this county who understand the mental health needs of prison inmates and are working diligently and creatively to address them.